Provider Demographics
NPI:1326125345
Name:C & R FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:C & R FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:616-554-0077
Mailing Address - Street 1:6208 KALAMAZOO AVE SE STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7022
Mailing Address - Country:US
Mailing Address - Phone:616-554-0077
Mailing Address - Fax:616-554-0055
Practice Address - Street 1:6208 KALAMAZOO AVE SE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7022
Practice Address - Country:US
Practice Address - Phone:616-554-0077
Practice Address - Fax:616-554-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRS008936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV05436Medicare UPIN
0P18560Medicare ID - Type Unspecified